OS AR 1/15/98 CWC A century long quest for meaningful and accurate occupational injury and illness statistics
A Century-Long Quest for Meaningful and Accurate
Occupational Injury and Illness Statistics
By Dino Drudi
Dino Drudi is an economist in the Office of Safety, Health, and Working
Conditions, Bureau of Labor Statistics. Telephone (202)606-6179
For over a century, the Bureau has collected and disseminated information
on occupational injuries and illnesses. Data collection methods have
evolved through trial-and-error. Recent program redesign takes ample
consideration of past lessons and holds great promise for success.
Immediate challenges still confront the occupational safety and health
program, however, as the Bureau embarks on its second century of
involvement with occupational injury and illness data.
President Chester A. Arthur signed the bill creating the Bureau of Labor
in the Department of the Interior on June 27, 1884. His signature
culminated two decades of advocacy by labor organizations seeking
government assistance in publicizing and improving the status of the
growing industrial work force. Those two decades following the War between
the States saw vast changes in the American economy and society. Those
decades brought about a national economy symbolized by the transcontinental
railroads. Rapidly growing industries attracted unprecedented numbers of
unskilled workers recruited from among immigrants, freed slaves, women, and
even children.(1)
Within a decade of the Bureau's establishment, from the mid-1890s on,
it published extensively on new developments in State and foreign social
legislation and practices, including accident prevention and workers'
compensation.(2) This began a long and continuing commitment to the
presentation of useful information on occupational safety and health.
In 1914, Royal Meeker, the Bureau's third Commissioner, asserted,
"The Bureau should be in a position to furnish at any time advice as to
the best methods of preventing industrial accidents and occupational
diseases."(3) By 1976, under Janet Norwood, the Bureau's tenth Commissioner,
the Survey of Occupational Injuries and Illnesses was the largest annual
sample survey conducted by the Bureau.(4) Occupational injury and illness
data have long been considered a staple among the Bureau's traditional
programs. These programs collect, tabulate, and publish data on employment,
wages, prices, and other economic measures used in labor economics and
general commerce.(5)
The Bureau, through virtually all its history, has relied on the
cooperation of State agencies for occupational safety and health data
collection. Carroll Wright, the Bureau's first Commissioner, envisioned a
network of collaborating State and Federal agents collecting and sharing
data. He called this network a "powerful chain of investigators." (6)
Starting with 3 States just before World War I, 14 States were
participating in the Bureau's safety and health statistics program by
1970, when the Occupational Safety and Health Act was passed. The Act
authorized BLS to make matching grants to the States to cover part of the
cost of providing occupational injury and illness data to BLS.(7) BLS also
offered to provide technical assistance and standardized data formats
allowing States to compare their injury and illness experience with other
States. Consequently, when the Census of Fatal Occupational Injuries
program began in 1992, all 50 States and the District of Columbia were
participating. In that same year, BLS introduced its redesigned annual
Survey of Occupational Injuries and Illnesses. This survey, which covers
nonfatal injuries and illness, had 42 States and several territories
participating in the program.
Rudimentary beginnings
The primary problem with counting occupational injuries and illnesses was
the difficulty associated with identifying comprehensive, uniform data
sources.
Before the 1890s, the chief barrier to occupational injury and illness
data was the lack of any statutory obligation for employers to report
workplace injuries to a State authority. Even thereafter, such duties
were limited and poorly enforced. The subsequent introduction of State
factory inspectors also had little impact, due to incomplete reports.
Differences between individual State reporting requirements further
precluded meaningful interstate comparisons.(8) Even the oldest and most
complete industrial injury data series - the statutory requirement for
railroads to report injuries to the Interstate Commerce Commission - was
not entirely trustworthy despite its enforceability by monetary
penalties.(9) These conditions in large part persisted until the passage
of the Occupational Safety and Health Act in 1970.
In 1907, Arthur Reeves, a commentator of the times, proposed, to no
avail, that States require all incidents be reported to their labor
bureaus, and that BLS's predecessor, the Bureau of Labor, prepare
national tabulations.(10) Ironically, while the wave of enactments of
workers' compensation laws in the 1910s provided a much broader and more
accurate source of work-related fatality statistics, widely differing
State workers' compensation statutes proved an insurmountable obstacle to
a nationally uniform, comprehensive reporting system.(11) The enactment
of workers' compensation statutes may actually have hindered development
of national occupational injury and illness statistics because many
policy makers believed that State workers' compensation statutes had
largely eliminated the problem.(12)
In the years preceding World War I, the Bureau began to give attention
to industrial incidents and occupational diseases. In 1909, BLS
conducted a study of phosphorous poisoning in the match-making
industry.(13) During this time, the Bureau also reported on lead
poisoning, railway incidents, mining fatalities, and other safety and
health topics.(14)
In 1910, BLS began issuing an annual report on injury rates in the iron
and steel industry. A few years later, the Bureau established cooperative
arrangements with three important industrial States- Massachusetts,
New York, and Ohio -for reporting industrial accidents.(15) The Bureau,
over the years, has also continued to conduct various special studies to
supplement its regular data series, and focus on areas of particular
interest.
Foundations of the present system
In 1926, BLS began an annual survey of the frequency and severity of
industrial injuries for several manufacturing industries. The data from
this survey were based on State records and reports from establishments
in these industries.(16)
In the late 1920s, Ethelbert Stewart, the Bureau's fourth Commissioner,
sought congressional authorization for a safety division within the
Bureau. This division was to act as a "clearing-house for the information
the States are gathering." (17)
While Stewart's efforts ultimately were unsuccessful, by 1930, data
covered a quarter of the workforce in some 30 manufacturing industries.(18)
In 1939, BLS added survey-based occupational fatality data, switching
from the previous method of periodically aggregating State workers'
compensation figures to voluntary direct reporting by employers.(19)
Unfortunately, this kind of survey-based data collection methodology
raised a serious potential for systematic bias in the data. More
specifically, cases of underreporting by employers with the worst
safety records, and consequent underestimation of the total number of
cases, began to appear.(20) For example, fewer than a third of the
construction firms sampled in 1948-49 provided usable fatality data to
BLS.(21)
In 1937, the Bureau adopted an injury classification system developed by
the forerunners of the American National Standards Institute. At the
request of Under Secretary of Labor J. D. Hodgson, the American National
Standards Institute formed a study group to "review available reporting
methods and standards of reporting injuries on a nationwide basis, and,
if necessary, develop a simple method of reporting injuries." (22)
The study found the standard's detailed severity descriptions for
different kinds of injuries and special exceptions were too complex.
The standard was also too insensitive to measure trends in injury
experience and did not capture any occupational illness data. Moreover,
it allowed employers to transfer injured workers to another job. As long
as employees could carry out the duties associated with the job to which
they were transferred, there was considered to be no time lost and,
consequently, no recordable injury.(23)
During World War II, the Bureau published monthly injury data for
industries of particular wartime importance. Because industrial incidents
could adversely affect wartime production, government agencies used these
data to identify industries and establishments with high injury rates.
The Bureau also undertook special studies to examine the effects of
long hours on industrial incidents. One study of operations at the
Frankford Arsenal in Philadelphia showed that incidents happened more
frequently during the extended hours than during the regular hours.(24)
The Bureau also conducted detailed studies of incidents in the foundry,
longshoring, and meatpacking industries.(25)
After the war, BLS expanded its survey of injury frequency and severity
to more manufacturing industries and began surveying nonmanufacturing
industries as well. By 1966, data were published for over 650
industries.(26)
From the late 1930s to the mid- 1960s, BLS also collaborated with the
National Safety Council (NSC), a congressionally-chartered private sector
organization with formal ties to the American National Standards Institute,
in an effort to improve the statistics. Together, NSC and BLS would go
over the latest information from BLS surveys, Council estimates and reports
from Council members, and special studies. They would also agree on the
occupational fatality totals both agencies would publish and on the
distribution of those fatalities among the major industry groups.
Consequently, during those years BLS and NSC published similar
estimates.(27)
Starting with data for 1965, BLS and NSC discontinued collaboration.
BLS relied upon its survey-based occupational fatality data, while the
NSC built its estimates on data gathered from a variety of sources.
These sources included the Federal Government, private sector
organizations, and its own members.(28)
After BLS initiated the Census of Fatal Occupational Injuries (CFOI)
program, the National Safety Council adopted the CFOI counts for 1992
and subsequent years. The National Safety Council adjusts the BLS counts
to exclude fatal injuries resulting from "intentional acts" (homicides
and suicides) included in the BLS fatality census.
Aside from this relatively minor methodological distinction, the National
Safety Council recognizes that BLS's new methodology "employs the most
satisfactory approach to identification of and collection of information
about fatal occupational injuries presently available."(29) BLS
occupational fatality data are sufficiently detailed to allow the National
Safety Council to identify the homicides and suicides contained in the
BLS data.
Table 1. Work injury fatalities and fatality rates, 1992-96
Employed
Year Fatalities (in thousands)(2) Fatalit rate (3)
----- ---------- ----------------- ----------------
1992 6,217 119,168 5.2
1993 6,331 120,778 5.2
1994 6,632 124,470 5.3
1995 6,275 126,248 4.9
1996 6,112 127,997 4.8
1 The fatality figures are from the Census of Fatal Occupational Injuries
program, 1992-96. These figures include work injury fatalities for all
age groups. The 1996 figure is preliminary; figures for all other years
are final.
2 The employment figures, except for military, are annual average estimates
of employed civilians 16 years of age and older, from the Current
Population Survey (CPS) 1992-96. The resident military figures, derived
from resident and civilian population data from the Bureau of the Census,
were added to the CPS employment totals.
3 The rate represents the number of fatal occupational injuries per 100,000
employed workers and was calculated as: (N/W) x 100,000, where
N = the number of work injury fatalites to
workers 16 years of age and older,
W = the number of employed workers,
100,000 = per 100,000 workers.
Table 1 presents data between 1992 and 1996 derived from the BLS
occupational fatality census. The table also contains Current
Population Survey employment data and an overall fatality rate.(30)
The Occupational Safety and Health Act of 1970 required the Labor
Department, in consultation with the Department of Health, Education, and
Welfare (now the Department of Health and Human Services), to "develop
and maintain an effective program of collection, compilation, and analysis
of occupational safety and health statistics." The Act required the
Department to "compile accurate statistics on work injuries and
illnesses... [for] all disabling, serious, or significant injuries and
illnesses, whether or not involving loss of time from work, other than
minor injuries requiring only first aid treatment and which do not
involve medical treatment, loss of consciousness, restriction of work or
motion, or transfer to another job."(31)
Responsibility for implementing this provision was given to BLS.
The Act required employers to maintain accurate records of work-related
fatalities, and nonfatal injuries and illnesses. Employers had to report
these incidents to BLS if selected for inclusion in a particular
year's annual survey. Initially, funding was provided as a pass-through
from the Occupational Safety and Health Administration. However, in
fiscal year 1992, the Congress included funds for the program as part of
the Bureau's budget.
The Bureau's voluntary survey became mandatory, thereby solving the
problem of nonsampling bias resulting from nonresponse, particularly
from employers with the worst safety records.(32) Private establishments
subject to the Act selected for a given year's survey were required to
report fatalities and nonfatal cases involving lost workdays, transfer to
another job, termination of employment, loss of consciousness, or
restriction of work or motion. Consequently, it would no longer be
possible to mask injuries by transferring injured workers to other jobs,
or retiring or dismissing them.(33)
Since 1973, occupational injury and illness numbers and incidence rates
for the private sector collected under the Act have been published.
They include data for both the private sector overall and for specific
private sector industries. Table 2 presents overall private sector data
from 1973 through 1995.
The Bureau simultaneously developed procedures to gather from State
workers' compensation records additional information on the worker and
case characteristics associated with work-related injuries and illnesses.
Introduced in 1976, this Supplementary Data System grew to 34
participating States by 1982. Data from State workers' compensation
systems met many data needs not fulfilled by the annual survey. However,
state systems' varying definitions of industries, workers, and cases
covered made interstate comparisons difficult and national aggregation
of State data even more problematic. By 1992, BLS-in response to a
National Academy of Sciences recommendation-phased out the Supplementary
Data System and expanded the annual survey. This expansion aimed to
capture worker and case characteristic data for nonfatal cases.(34)
In 1977, the Bureau initiated a series of direct studies of injured
workers called Work Injury Reports (WIR).(35) These reports provided
detailed information on the causes and effects of selected workplace
injuries and illnesses. The reports used questionnaires mailed to
injured or ill workers by States participating in the Supplementary
Data System. From 1978 until 1990, the Bureau issued numerous studies
on varied topics such as back injuries associated with lifting and eye
injuries. WIR surveys were designed, often in cooperation with the
Occupational Safety and Health Administration, to identify patterns of
incident causes, the activities in which the worker was engaged at the
time of the incident, specifics about the equipment used, the personal
protective equipment being worn, any training the employee received, etc.
The BLS Handbook of Methods for Surveys and Studies explains the rationale
behind Work Injury Reports further:
Because it would be difficult, if not impossible, for employers to
provide some of the needed information, [BLS decided to] survey injured
workers directly. For example, by surveying the worker directly, it is
possible to expand the scope of questions on work being done... to
include safety training, and prior experience, if any, provided by
previous employers. Such information helps safety and health
experts... zero in on... workers who lacked any safety training on the
work activity they performed when injured.(36)
The modern era of safety and health statistics
In 1984, the Congress appropriated funds to study BLS occupational injury
and illness statistics. BLS turned to the National Academy of Sciences
to conduct the study. After the study's completion in October 1987, the
Bureau totally redesigned its occupational injury and illness statistical
program.(37) A panel from the Keystone Dialogue Group (a nonprofit private
sector organization that facilitates consensus building discussions among
business, labor, and government on public policy issues) also contributed
recommendations for redesigning the statistical program.(38) The chief
criticisms of the survey were that it shed little light on the
demographics of injured and ill workers or the characteristics of the
incident, such as the kind of injury or illness involved, how it
happened, and the specific kind of job involved.
Table 2. Nonfatal occupational injury and illness incidence rates and
numbers for private sector industries, 1973-95
----------------------------------------------------------------------------------------------------------
| Injury and illness incidence rates(2) | Number of injuries and illnesses (000's) |
|---------------------------------------------------------------------------------------------|
| |Lost workday cases | | | Lost workday cases -| |
| Total |---------------------| Cases | Total |---------------------| Cases |
Year(1) | cases | | With days |without lost| cases | | With days |without lost|
| | Total(3)| away from | workdays | | Total(3)| away from | workdays |
| | | work(4) | | | | work(4) | |
----------------------------------------------------------------------------------------------------------
1973 | 11.0 | 3.4 | - | 7.5 | 6,078.7 | 1,908.0 | - | 4,165.0 |
1974 | 10.4 | 3.5 | - | 6.9 | 5,915.8 | 2,001.8 | - | 3,908.1 |
1975 | 9.1 | 3.3 | 3.2 | 5.8 | 4,983.1 | 1,825.2 | 1,730.5 | 3,152.6 |
1976 | 9.2 | 3.5 | 3.3 | 5.7 | 5,163.7 | 1,978.8 | 1,875.4 | 3,180.4 |
1977 | 9.3 | 3.8 | 3.6 | 5.5 | 5,460.3 | 2,203.6 | 2,092.1 | 3,250.6 |
1978(5) | 9.4 | 4.1 | 3.8 | 5.3 | 5,799.4 | 2,492.0 | 2,327.5 | 3,302.0 |
1979(5) | 9.5 | 4.3 | 4.0 | 5.2 | 6,105.7 | 2,757.7 | 2,553.5 | 3,342.3 |
1980 | 8.7 | 4.0 | 3.7 | 4.7 | 5,605.8 | 2,539.9 | 2,353.8 | 3,060.4 |
1981 | 8.3 | 3.8 | 3.5 | 4.5 | 5,404.4 | 2,457.5 | 2,269.2 | 2,941.8 |
1982(5) | 7.7 | 3.5 | 3.2 | 4.2 | 4,856.4 | 2,182.4 | 2,016.2 | 2,668.6 |
1983(5) | 7.6 | 3.4 | 3.2 | 4.2 | 4,854.1 | 2,182.7 | 2,014.2 | 2,667.6 |
1984 | 8.0 | 3.7 | 3.4 | 4.3 | 5,419.7 | 2,501.5 | 2,303.7 | 2,913.4 |
1985 | 7.9 | 3.6 | 3.3 | 4.3 | 5,507.2 | 2,537.0 | 2,319.2 | 2,965.9 |
1986 | 7.9 | 3.6 | 3.3 | 4.3 | 5,629.0 | 2,590.3 | 2,356.9 | 3,034.6 |
1987 | 8.3 | 3.8 | 3.4 | 4.4 | 6,035.9 | 2,801.6 | 2,483.9 | 3,230.6 |
1988 | 8.6 | 4.0 | 3.5 | 4.6 | 6,440.4 | 2,977.8 | 2,585.8 | 3,458.7 |
1989 | 8.6 | 4.0 | 3.4 | 4.6 | 6,576.3 | 3,073.9 | 2,624.2 | 3,497.9 |
1990 | 8.8 | 4.1 | 3.4 | 4.7 | 6,753.0 | 3,123.8 | 2,613.5 | 3,625.6 |
1991 | 8.4 | 3.9 | 3.2 | 4.5 | 6,345.7 | 2,944.2 | 2,398.4 | 3,398.3 |
1992(6) | 8.9 | 3.9 | 3.0 | 5.0 | 6,799.4 | 2,953.4 | 2,331.1 | 3,846.0 |
1993(6) | 8.5 | 3.8 | 2.9 | 4.8 | 6,737.4 | 2,967.4 | 2,252.5 | 3,770.0 |
1994(6) | 8.4 | 3.8 | 2.8 | 4.6 | 6,766.9 | 3,061.0 | 2,236.6 | 3,705.9 |
1995(6) | 8.1 | 3.6 | 2.5 | 4.4 | 6,575.4 | 2,972.1 | 2,040.9 | 3,603.2 |
----------------------------------------------------------------------------------------------------------
1 Data for 1973-1975 are based on the Standard Industrial Classification
Manual, 1967 Edition; data for 1976-1987 are based on the Standard
Industrial Classification Manual, 1972 Edition; and data for 1988-1995 are
based on the Standard Industrial Classification Manual, 1987 Edition.
2 The incidence rates represent the number of injuries and illnesses
per 100 full-time workers and were calculated as: (N/EH) X 200,000, where:
N = number of injuries and illnesses,
EH = total hours worked by all employees
during the calendar year,
200,000 = base for 100 full-time equivalent
workers (working 40 hours per week,
50 weeks per year).
3 Total includes cases involving restricted work activity only, in
addition to days-away-from-work cases with or without restricted work
activity.
4 Days-away-from-work cases include those which result in days away from
work with or without restricted work activity.
5 To maintain historical comparability with the rest of the series, data
for small nonfarm employers in low-risk industries who were not surveyed
were imputed and included in the survey estimates.
6 Data for 1992-1995 exclude fatal work-related injuries and illnesses.
NOTE: Because of rounding, components may not add to totals. Data for
1976-1995 exclude farms with fewer than 11 employees. Dashes denote data
not available.
BLS redesigned the annual survey to add the collection of demographic data
on workers whose injuries and illnesses required recuperation away from
work. The new survey also collected detailed information about the
circumstances of workers' injuries and illnesses. The demographic and
economic information includes industry, occupation, age, gender, race or
ethnic origin, and length of service with the employer. The case
circumstance data include the physical characteristics of the injury or
illness, what happened, how it happened, and what equipment, materials,
tools, or substances directly inflicted the injury or led to the exposure.
BLS scrapped the old American National Standards Institute (ANSI) Z16.2
rules of selection and codes, and devised an entirely new classification
structure containing considerably more guidance and detail. In September
1995, ANSI adopted the Bureau's new coding structure as a national
standard.(39)
While BLS retained from the old ANSI Z16.2 rules the Nature of Injury or
Illness, Part of Body Affected, and Source of Injury or Illness concepts,
it retitled "Type of Accident or Exposure" as "Event or Exposure" to
emphasize that some events, such as assaults, are not "accidental."
They also replaced the Supplementary Data System's Associated Object or
Substance classification with an entirely new classification titled
"Secondary Source." New definitions, rules of selection, and detailed
codes were implemented for all five classifications. In the new scheme,
source and secondary source use identical codes.(40) Associated object or
substance, designed to identify the object, substance, or person with
respect to which measures could have been introduced to prevent the
incident or mitigate the injury or illness, had proven unusable because it
was too vague and subjective. By contrast, secondary source is designed to
identify objects, substances, or persons generating the source of injury
or illness or contributing to the event or exposure. It recognizes that
many cases have no secondary source associated with them.
The new survey design balanced safety and health professionals' desire
for expanded data with employer burden and survey expense considerations.
For example, cases resulting in only restricted work or motion or medical
treatment continued to be summarized, rather than studied in detail.
Employers were permitted to submit supplementary forms containing the
requisite information, such as workers' compensation reports, instead of
completing corresponding parts of the questionnaire. Employers with
relatively large numbers of days away from work cases were allowed to
provide a randomly selected subset of their cases for the year.
The National Academy of Sciences also expressed concern with the high rate
of sampling error for the survey estimates of work-related fatalities.
Although there are a significant number of job-related fatalities each
year, they are a very small proportion of all workplace injuries and
illnesses. Thus, work-related fatalities are statistically "rare events,"
which cannot be measured with high accuracy by a sample survey.
The National Academy of Sciences recommended that BLS compile a universe of
fatalities, which only a census could provide. Consequently, BLS eschewed
the notion of gathering fatality data through the annual survey.
Simultaneous with expansion of the annual survey in 1992, BLS launched the
Census of Fatal Occupational Injuries (CFOI) which assembles data on all
work-related fatal injuries from a diverse array of sources. CFOI, which
expanded the scope of data beyond those used by Federal and State agencies
administering specific laws and regulations to include all industries and
occupations, aims to include all workers who had died on the job and who
had worked for pay, compensation, or profit at the time of the fatal event.
They are included in the census only if, at the time of the fatality, they
were engaged in a legal activity and were present at the site of the
incident as a job requirement. CFOI also captures worker and case
characteristics.(41)
CFOI is able to accomplish this by drawing information on fatal work
injuries from as many as 25 different source documents - including death
certificates, State workers' compensation reports, news media accounts,
and State motor vehicle incident reports. Information is also provided
from such diverse sources as State farm bureaus, local police departments,
emergency medical services, and the National Association of Chiefs of
Police. In addition, other Federal agencies having jurisdiction over or
compiling data about fatalities affecting specific groups of workers
provide data to BLS. These agencies include the Occupational Safety and
Health Administration, the Employment Standards Administration, the Mine
Safety and Health Administration, the Department of Defense, the U.S.
Coast Guard, the Department of Justice, and the National Transportation
Safety Board.
As table 3 shows, no single source is completely adequate for identifying
all occupational fatalities. However, when several sources are used, a
fatality missed by one may be captured by another and will ultimately be
included in the data. For 1995, over 18,000 source documents were used to
identify and verify information on over 6,000 job-related fatal injuries.
Using multiple sources also provides more detailed information about the
circumstances surrounding fatal occupational injuries. Information
collected from various source documents is used to code up to 30 data
elements for each job-related fatality.
Table 3. Source documents used to compile information on fatal work injuries, Census of Fatal Occupational Injuries, 1995
Initiating
Source Total
Documents
---------------------------- --------- -------
Death certificates 2,114 4,894
News media reports 1,699 2,616
State workers' compensation 945 2,304
State coroner/medical reports 125 2,070
OSHA reports 669 2,041
State-initiated follow-ups - 1,555
State motor vehicle reports 93 598
Other Federal reports 60 238
Other 500 2,111
--------------------------------------------------
1 Death certificates marked "at work."
Data needs in the near future
The introduction of the CFOI program, and the redesign of the annual
Survey of Occupational Injuries and Illnesses, which occurred near
the century mark of BLS's involvement in occupational safety and
health research, raise occupational safety and health statistics to a
new level of sophistication. These two statistical series open up new
opportunities for understanding, and devising strategies to address,
job-related hazards. But will they define the status quo for the
foreseeable future, or will the state of the art further advance?
Summary statistics often point at areas where further detailed studies
could focus. For example, the incidence of disorders associated with
repeated trauma increased elevenfold between 1982 and 1994. Summary
data provide a wealth of useful information about these conditions, such
as: there were 332,100 repeated trauma cases in 1994, accounting for
41.1 cases per 10,000 full-time workers, and they tend to concentrate
in industries such as meat packing and motor vehicle and car body
manufacturing.(42)
But, further research by safety and health professionals might show
the extent to which carpal tunnel syndrome and other repetitive motion
disorders underlie this 12-year change; the tools, machinery, or
equipment involved; etc. Gaining further insight into how disorders
associated with repeated trauma occur may lead to measures that could
be taken to prevent them.
Bureau data highlight diverse areas needing such special attention, and
point in directions further research might explore. For example, safety
and health professionals could conduct studies to gain insights into
the causes of serious injuries and illnesses. Studies of this kind
would investigate such issues as how well equipment is designed,
whether training on the use of tools or equipment sufficiently
addresses safety and health considerations, or whether some hazards are
inherent in the nature of certain kinds of work.
There is also a growing need for more detailed information on the
costs associated with fatal and nonfatal injuries and illnesses, and
the cost savings that would accrue from particular injury and illness
reduction strategies. Both the costs incurred consequent to injuries
and illnesses, and the benefits that would accrue from their prevention
and mitigation, are of two kinds:
* Internalized costs borne
directly by employers, injured
employees, and insurers such
as workers' compensation
premiums and payouts, lost
employee income if the injury
or illness does not exceed the
workers' compensation
waiting period, and lost
productivity; and
* Externalized social costs
borne by society at large, such
as increased welfare payments
for disabled workers not
covered by workers' compen-
sation and their families.
Because employers keep records of their costs, it is generally easier
to quantify costs borne directly by employers (internalized costs),
than those borne by society at large (externalized costs).
A sentinel event is an incident whose occurrence is a warning signal
that the quality of occupational injury and/or illness prevention efforts
may need to be improved.(43)
An example might be a hammer falling off a high girder on a construction
site. The hammer could fall harmlessly to the ground; could fall on
an expensive piece of equipment; could just barely miss a worker on
the ground; could hit the worker in the shoulder, putting him out for
a few days to recuperate; could glance harmlessly off the hard hat on
his head; or could inflict a fatal skull fracture if he is not
wearing his hard hat. If careless practices develop, such as leaving
tools unsecured high up in the structural steel frame of the building,
the hammer that falls harmlessly to the ground today could fall fatally
on a worker's head tomorrow. The hammer falling harmlessly to the ground
is the sentinel event pointing to a hazardous condition that should be
addressed to prevent a more serious injury.
One school of thought holds that only events that result in injury or
illness should be measured and fall within the scope of desired
prevention efforts. This school of thought also believes that the
best hazard- indicators are incidents that actually produce
work-related injuries or illnesses. This belief is increasingly
predominant as agencies move to cut costs and employer recordkeeping
burden. BLS currently collects occupational injury and illness data
only for cases that result in actual injuries or illnesses.
However, another school of thought believes statistical systems should
be designed to identify a broader range of sentinel events, so safety
and health professionals will be aware of hazards before an injury or
illness-producing event or exposure occurs, rather than after it has
already occurred, where data about it can serve only to prevent some
future event or exposure. An example of including such sentinel events
in a safety program is the Federal Aviation Administration's tracking
aircraft "near misses."
The efficacy of capturing data on sentinel events rests on an assumption
that the fundamental characteristics of actual injuries and illnesses
are similar to those of sentinel events resulting in no injury or
illness. For example, the falling hammer might not have struck
anyone because the worker who inadvertently dropped it may have looked
over and shouted a warning to those on the ground, alerting them to
the hazard in time for them to move safely out of the way.
Conclusion
Patricia C. Cohen observes that "in the nineteenth century, what was
counted was what counted",(44) which labor economist Marc Linder
suggests is every bit as true in the twentieth century as well.(45) And
it may well be a universal truth.(46)
Cohen notes that the political origins, design, collection, and uses
of economic data are in part based on the insight that counting methods
embody assumptions about the objects of enumeration.(47) And Linder,
citing Arthur Reeves, reminds us that for a long time in American
history such objects of enumeration as fatal and nonfatal occupational
injuries and illnesses were not considered important enough to count.(48)
Indeed, J.M. Clerc went so far as to state that, at certain junctures
in American history, occupational injuries and diseases were considered
the inevitable tribute to the progress of the American economy.(49)
It remains ironic that both those like Linder, who decry on-the-job
"casualties," and those whom Clerc describes as considering
these "casualties" to be a measure of economic progress, have a
common interest in meaningful and accurate occupational injury and
illness statistics. Moderates such as Carroll Wright, the Bureau's
first Commissioner, were called upon to keep track of what one of
his contemporaries, C.H. Mark, characterized as the "stupendous loss"
of life and injury experience consequent to industrialization.(50)
Despite the progress BLS has made over the past century, the Bureau,
like other sources of occupational injury and illness data, found
itself confined by legal strictures and lack of appropriate data
sources. Until the advent of the BLS Census of Fatal Occupational
Injuries program, for example, consensus on a fatal work injury
count eluded BLS and other organizations attempting to quantify
this phenomenon.(51)
Early attempts to develop accu-rate fatality data saw fruition only
by 1992. It was then that BLS recognized that a diversity of data
sources would be necessary to secure good data on fatal work-related
injuries.
Similarly, BLS vacillated between collecting occupational injury and
illness data by means of direct survey versus piggybacking on State
workers' compensation records. Neither method worked particularly
well, due, respectively, to survey underreporting by the firms with
the worst injury and illness records in the years preceding the
Occupational Safety and Health Act,(52) and interstate variations in
waiting periods and other workers' compensation requirements. But, by
allowing employers to use workers' compensation forms to the extent
they provide information sufficient to fulfill the Occupational Safety
and Health Act's requirements,(53) the Act created the practical framework
to enable BLS to reconcile these two methods of data collection and take
advantage of the best aspects of each. Consequently, in the 1992
redesign, BLS began accepting workers' compensation forms as input to
the survey of nonfatal occupational injuries and illnesses, to the extent
workers' compensation forms contain the requisite information.
Just as the present system of occupational safety and health statistics
might not have been imaginable a century ago when the Bureau began
publishing information on this topic, it is not clear whether budgetary
conditions, public demand, or available information resources will
enable organizations producing safety and health statistics to improve
upon the usefulness of their data. Will there be sufficient resources
to undertake special follow-up studies, improve cost data, or develop
information on sentinel events in the proximate future?
What does the century-long effort to produce meaningful and accurate
statistics tell us about occupational injury and illness statistics
today, and the statistics needed for tomorrow's demands? Will other
issues suddenly appear that become more pressing? The future can be
filled with surprises that mock today's expectations.
-ENDNOTES-
1 Joseph P. Goldberg and William T. Moye, The First Hundred Years of the
Bureau of Labor Statistics, Bureau of Labor Statistics, Bulletin 2235,
September 1995, p. 1.
2 Ibid., p. 26.
3 Ibid., p. 100; Presidential Papers, Wilson Administration, Letter
from Meeker to Presidential Secretary Joseph Tumulty, February 6, 1914.
4 Goldberg and Moye, The First Hundred Years, p. 252.
5 Ibid., pp. 115, 259.
6 Ibid., p. 14.
7 Joseph W. Hines and Gunnar Engen, "BLS Regional Offices: 50 Years of
Federal-State Cooperation," Monthly Labor Review, December 1992, p. 40.
8 Marc Linder, "Fatal Subtraction: Statistical MIAs on the Industrial
Battlefield," Journal of Legislation, Notre Dame Law School, Vol. 20,
No. 2, 1994, pp. 106-107.
9 Industrial Accident Statistics, Bureau of Labor Statistics, Bulletin
157, March 1915, p. 7.
10 Authur Reeves, "Our Industrial Juggernaut," Everybody's Magazine,
1907, p. 156.
11 Linder, "Fatal Subtraction," pp. 106-107.
12 In the hearings on S. 3983, a bill to create a Division of Safety
in the Department of Labor, before the Senate Committee on Education
and Labor, 69th Congress, 1926, Connecticut Senator Hiram Bingham said:
[In] Connecticut... [w]e passed an employer's liability compensation act,
which requires all employers... to see to it that their employees should
be protected at work. Now, this had the very natural effect of making
the manufacturers do what they should have done before, look into the
causes of their own accidents and guard against them. [T]his is the
proper theory of government, put on the individual the initiative of
seeing to it that he corrects his own errors, rather than to have
the Government to tell him what he must do in order to correct them, and
that is the reason, I take it, why we do not find it necessary to collect
accident statistics any more; it is because the workmen are protected,
and the manufacturers themselves are seeing to it that they can and
do establish the very latest form of safety devices, for their own
protection, and for the saving in insurance, and for the safety of
their workers.
13 John B. Andrews (Secretary, American Association for Labor
Legislation), "Phosphorous Poisoning in the Match Industry in the
United States," Bulletin 86, January 1910, pp. 31, 145-146; Hearings on
Health Activities of the General Government before the House Committee
on Interstate and Foreign Commerce, 61st Congress, 1910, pt. VI, p. 408.
14 Goldberg and Moye, The First Hundred Years , pp. 58, 60.
15 Hines and Engen, "BLS Regional Offices," p. 40.
16 Goldbert and Moye, The First Hundred Years, p. 133; Lyle R. Schauer
and Thomas S. Ryder, "New Approaches to Occupational Safety and Health
Statistics," Monthly Labor Review, April 1972, p. 14.
17 Hearings on Establishing a Division of Safety before the House
Committee on Labor, 69th Congress, 1926, p. 16.
18 Goldberg and Moye, The First Hundred Years, p. 133.
19 Max Kossoris and Swen Kjaer, "Industrial Accidents in the United
States During 1939," Monthly Labor Review, October 1940, pp. 86, 89.
20 Linder, "Fatal Subtraction," p. 115; Schauer and Ryder, "New
Approaches to Occupational Safety," pp. 14-19; Dino Drudi, "The Evolution
of Occupational Fatality Statistics in the United States," Compensation
and Working Conditions, Bureau of Labor Statistics, June 1995, p. 2.
21 Work Injuries in Construction, 1948-49, Bureau of Labor
Statistics, Bulletin 1004, 1950, pp. 2-3.
22 Proposed National System for Uniform Recording and Reporting of
Occupational Injuries and Illnesses, American National Standards Institute,
1970, p. 10.
23 Schauer and Ryder, "New Approaches to Occupational Safety," pp. 14-19.
24 Goldberg and Moye, The First Hundred Years, pp. 169-170.
25 Ibid., p. 170.
26 Ibid., p. 205.
27 Documentation of National Safety Council Statistics Department
Estimating Procedures for Motor Vehicle, Work, Home, and Public Deaths
and Death Rates, National Safety Council, February 1982, pp. 7-8; BLS
Handbook of Methods for Surveys and Studies, Bureau of Labor Statistics,
Bulletin 1458, 1966, p. 205. In 1954, Commissioner of Labor Statistics
Ewan Clague explained to the President's Conference on Occupational Safety
that, because BLS cannot obtain a complete count of fatal work injuries,
the BLS and National Safety Council technical staffs "assemble all these
bits and pieces of work-injury data, fit them together like pieces in a
jigsaw puzzle... match them up... and make adjustments so the figures will
be comparable." (See The President's Conference on Occupational Safety:
Proceeding, May 4-6, Bureau of Labor Statistics, Bulletin 175, 1954,
pp. 7-8.)
28 Hearings on the Occupational Safety and Health Act Review before
the Subcommittee on Labor of the Senate Committee on Labor and
Public Welfare, 93rd Congress, 1974, pp. 92-93.
29 Correspondence from Alan F. Hoskin, Statistics Department Manager,
National Safety Council, to Karin G. Kurz, BLS Clearance Officer, November
29, 1995.
30 For further discussion of BLS's experimental fatality rate data,
see Fatal Workplace Injuries in 1992: A Collection of Data and Analysis,
Bureau of Labor Statistics, Report 870, April 1994, pp. 4-5.
31 Occupational Safety and Health Act, Public Law 91-596, 84 Stat.
1590, @24, 1970.
32 For further explanation, see Linder, "Fatal Subtraction," p.
115; Schauer and Ryder, "New Approaches to Occupational Safety," pp.
14-19; and Drudi, "The Evolution of Occupational Fatality Statistics," p. 2.
33 Schauer and Ryder, "New Approaches to Occupational Safety," p. 14.
34 Although the Supplementary Data System proved ill-suited to
providing national statistics and was discontinued, BLS provided
interested States with formats to enable them to continue using it
for State-level administrative statistics. As recently as 1995, data
similar to those provided to BLS under the Supplementary Data System were
being actively used on the State level. OSHA, in cooperation with one
such State, undertook a special project using workers' compensation claims
to identify the 200 companies with the worst health and safety records.
While these companies represented only 1 percent of the State's
employers, they accounted for almost a third of the State's workers and
almost half its compensable injuries and illnesses. OSHA later expanded
the program to other States. See Frank Swoboda and Stephen Barr,
"Guardian of Employee Safety Is About to Get a Work-Over: White House
Promises New OSHA Mind-Set to Rely on Cooperation," The Washington Post,
May 16, 1995, p. A15.
35 Goldberg and Moye, The First Hundred Years, p. 252.
36 BLS Handbook of Methods for Surveys and Studies, Bureau of Labor
Statistics, Bulletin 2414, 1992, p. 117.
37 Counting Injuries and Illnesses in the Workplace: Proposals for
a Better System, National Academy of Sciences, National Research Council,
Washington, DC, 1987.
38 Keystone National Policy Dialogue, on Work-Related Illness and Injury
Recordkeeping, The Keystone Dialogue Group, Keystone, Colorado, January 1989.
39 Guy Toscano, Janice Windau, and Dino Drudi, "Using the BLS
Occupational Injury and Illness Classification System as a Safety and
Health Management Tool," Compensation and Working Conditions, Bureau of
Labor Statistics, June 1996, pp. 19-23.
40 Occupational Injury and Illness Classification Manual, Bureau of
Labor Statistics, December 1992.
41 Guy Toscano and Janice Windau, "The Changing Character of Fatal Work
Injuries," Monthly Labor Review, October 1994, p. 17.
42 Occupational Injuries and Illnesses: Counts, Rates, and
Characteristics, 1994, Bureau of Labor Statistics, Bulletin 2485, April
1997, p. 7.
43 Paul J. Seligman and Todd M. Frazier, "Surveillance: The Sentinel
Health Event Approach," Public Health Surveillance, ed., by William
Halperin and Edward L. Barker, Jr., Van Norstrand Reinhold, 1992, p.
16, derived from A.D. Langmuir, "William Farr, Founder of Modern
Concepts of Surveillance," International Journal of Epidemiology,
Vol. 5, No. 1, 1976.
44 Patricia Cohen, A Calculating People: The Spread of Numeracy in
Early America, 1982, p. 207.
45 Linder, "Fatal Subtraction," p. 106.
46 Drudi, "The Evolution of Occupational Fatality Statistics," p. 1.
47 Cohen, A Calculating People, p. 211.
48 Linder, "Fatal Subtraction," p. 106, Reeves, "Our Industrial
Juggernaut," 1907, p. 147.
49 J.M. Clerc, Introduction to Working Conditions and Environment,
Vol. 29, 1985.
50 C.H. Mark, "Our Murderous Industrialism," World Today, Vol. 12,
1907, p. 97.
51 The BLS survey of occupational injuries and illnesses estimated
that there were 2,900 work-related fatalities during 1990. For the
same year, the National Safety Council estimated 10,500 work-related
fatalities. The National Institute for Occupational Safety and Health's
National Traumatic Occupational Fatality program estimated 5,500
work-related fatalities in 1990 for the United States, except
Connecticut and New York City.
National Safety Council estimates cover unintentional injury-related
deaths involving persons in the civilian labor force, 14 years and older,
except for private household workers. Homicides and suicides are excluded.
See Accident Facts: 1994 Edition, National Safety Council, Itasca,
Illinois, 1994, p. 39.
National Institute for Occupational Safety and Health estimates cover
traumatic injuries (intentional and unintentional) of persons 16 years
and older identified on the death certificate as occurring "at work."
While death certificates cover all deaths occurring in a State, only
those death certificates identifying a fatal injury as one that occurred
"at work" (i.e., the "at work" box on the death certificate is
checked-off) are used to compile the number of fatal occupational
injuries. Persons completing the death certificate might not recognize
the work relationship of some injuries, such as automobile crashes. For
further discussion of methodology, see National Traumatic Occupational
Fatalities: 1980-1985, National Institute for Occupational Safety and
Health, March 1989.
State and Federal workers' compensation reports also fail to capture a
census of fatal occupational injuries. The self-employed; employees
of small farms, private households, and railroads; and seasonal employees
are generally excluded from workers' compensation coverage.
52 For further explanation, see Linder, "Fatal Subtraction," p. 115;
Schauer and Ryder, "New Approaches to Occupational Safety," pp. 14-19;
and Drudi, "The Evolution of Occupational Fatality Statistics," p. 2.
53 Schauer and Ryder, "New Approaches to Occupational Safety," p. 15.
Compensation and Working Conditions Winter 1997